MEDICARE: MARICELA PENA JIMENEZ RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-21-187244	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811659493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARICELA PENA JIMENEZ RBT

Provider Business Mailing Address
First Line	:	13911 N DALE MABRY HWY STE 108
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2414
Country	:	US
Telephone Number	:	813-784-3619
Fax Number	:

Provider Business Practice Location Address
First Line	:	13911 N DALE MABRY HWY STE 108
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2414
Country	:	US
Telephone Number	:	813-784-3619
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2021
Last Update Date	:	03/11/2026

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Directions to “ MARICELA PENA JIMENEZ RBT” Practice Location

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